Statement on the Surgical Workforce

Online August 1, 2007

The following statement was developed by the ACS Health Policy Steering Committee and was approved by the Board of Regents at its June 2007 meeting.

The American College of Surgeons is concerned that access to surgical care is eroding in many U.S. communities. An aging population, unstable practice environment, geographic differences in the liability climate, changing lifestyle expectations, technological changes, and an increasing tendency toward subspecialization are combining to produce surgical workforce shortages. This problem is most evident and widespread in rural areas and in our nation’s trauma centers and emergency departments, as noted in the Institute of Medicine’s 2006 reports on the future of emergency care. Increasingly, our urban and suburban communities are facing shortages as well.

Much attention has been focused recently on a declining physician-to-population ratio in the U.S. that will accelerate as the baby boom generation ages. Although policy-makers have devoted considerable discussion to developing solutions for a predicted shortage of generalists, little attention has been devoted to surgical workforce limitations. Notably, the number of surgeons being produced by our graduate medical education system has remained stable for nearly 30 years. In general surgery, for example, the ratio of surgeons-to-population has been declining steadily since 1985. In other specialties, where the supply is limited to only a few thousand, surgeons are finding that they are unable to meet community demands for their services. Furthermore, there is evidence that many surgeons have narrowed their practices to include only outpatient care, whereas others have subspecialized to the point where they no longer feel qualified to serve on emergency call panels. In addition, relatively few women choose surgery as a career, which is especially troubling now that more than half of medical school enrollees are women.

The American College of Surgeons supports measures to ensure access to surgical specialty care. More specifically, the College believes the federal government should do the following:

Develop national self-sufficiency in the production of physicians, surgeons, and other health professionals through a well-planned expansion of U.S. medical school graduates and residencies

Provide full federal support for needed specialties with long training requirements

Remove the caps that were imposed by the Balanced Budget Act on the number of residents eligible for federal support at each training institution under Medicare

Expand programs of support for rural physicians to include surgical specialties